GAO: NEXT OPEN ENROLLMENT FACES 'SIGNIFICANT RISKS’ — The GAO official blasting CMS for poor oversight of the HealthCare.gov contractors warns that unless the agency gets its act together, "significant risks remain that upcoming open enrollment periods could encounter challenges." So says William Woods, GAO's director of acquisition and sourcing management, who will testify today at the House Energy and Commerce oversight subcommittee hearing. A GAO report released yesterday concluded that the HealthCare.gov tech job was done "without effective planning or oversight practices." CMS says it has already done what the GAO suggests and more, firing main contractor CGI, changing its new contracts and putting oversight safeguards in place.

Welcome to PULSE, where I’m greeting you this morning with a light fist bump. I don’t care if a firm handshake is more professional: According to a new study published in the American Journal of Infection Control, shaking hands is most effective at transferring germs. http://nyti.ms/1rQPNWz

“Baby, these fists will always protect PULSE. And this mind, will never neglect PULSE.”

MASS GOV. PATRICK SIGNS BUFFER ZONE REPLACEMENT LAW — About a month after the Supreme Court struck down the state’s buffer zone law, Massachusetts Gov. Deval Patrick on Wednesday signed a new law intended to withstand the court’s scrutiny. But other buffer zones remain in limbo in three states and 16 cities around the country, Pro’s Paige Winfield Cunningham reports. About a half-dozen of these laws could be affected by the court ruling, expects Planned Parenthood President Cecile Richards. City officials in Portland, Maine, and Burlington, Vt., already have stopped enforcing their buffer zones. But it remains to be seen how the ruling will be interpreted, as the Supreme Court made clear it only applied to the Massachusetts law, and how other laws, such as those that create “bubble zones,” will fare. The Pro story: http://politico.pro/1n4iHuq

--The new Massachusetts law will enable law enforcement officials to keep individuals who are obstructing access away from the clinics — at least 25 feet away — for a period of eight hours. The bill also adopts a state version of the federal Freedom of Access to Clinic Entrances Act, which forbids the use or threat of force against an individual arriving at or leaving a clinic, and allows the attorney general to seek damages on behalf of affected individuals under the Massachusetts Civil Rights Act.

DOCS STILL GLOOMY ABOUT ‘SUNSHINE’ — Registering takes forever, you can’t save your data, and, oh, you can only use Internet Explorer. The AMA collected a litany of complaints about the verification system for the “Sunshine Law,” the ACA provision requiring pharmaceutical and device manufacturers to disclose their payments to doctors. Physicians have until Aug. 27 to check their data and dispute errors before the info goes public on Sept. 30, but the AMA says this is just another reason CMS should push the process back. CMS says it’s fixed glitches and made improvements, and doctors can even track their data with an Open Payments iPhone app. But they still can’t check the system with Safari — it’s the last incompatible browser. The Pro story: http://politico.pro/1qpb9FN

**A message from the Partnership for the Future of Medicare: Medicare is celebrating another birthday, but without moving away from our current fee-for-service model, Medicare will become insolvent by its own 65 th birthday. Bi-partisan consensus exists around ways to move us from volume to value. Read more about the path forward: http://bit.ly/YbmEYT **

REPUBLICANS CALL FOR IMPROVED SUBSIDY VERIFICATION — Sens. Chuck Grassley of Iowa, Orrin Hatch of Utah and Rob Portman of Ohio sent HHS Secretary Sylvia Burwell a letter Wednesday asking her what’s up with the ACA’s subsidy verification system. The senators pointed to a GAO report issued last week showing that some employees were able to obtain subsidies through HealthCare.gov using fictitious identities. They said that report contradicts a Jan. 1 certification from HHS that the exchanges were successfully verifying applicants’ eligibility for subsidies. “Several pieces of new information have recently emerged that call the accuracy of HHS’ certification into serious doubt,” the senators wrote to Burwell, asking her what she’s doing to ensure the system is working correctly. The letter: http://1.usa.gov/1zwKexh

SILVER PLANS: COST-SHARING VARIES BIG TIME — Silver plans are supposed to have an actuarial value of 70 percent, but how plans arrive at that figure varies. Breakaway Policy Strategies examined the 1,208 silver plans in all 50 states and D.C. and found that cost-sharing for silver plans is all over the place. Co-payments for primary care physician visits can cost anywhere from nothing to $75 and $10 to $150 for specialist visits. Co-insurance rates for PCP visits can range from 0 to 50 percent and 8 percent to 100 percent for specialist visits. The researchers’ takeaway: Consumers should look at more than just the premium when considering a plan design. The report, released Wednesday, was funded by the Robert Wood Johnson Foundation: http://bit.ly/UBPEaR

GEOGRAPHY AND GME BATTLES— We gave you the IOM perspective earlier this week on the $15 billion the government pours into graduate medical education and some pushback on its new report’s recommendations. Kaiser Heath News’ Julie Rovner also found some sharp scalpels. She quotes Gail Wilensky, co-chair of the advisory panel that issued the report, as expressing surprise that the system has “tolerated this peculiar distribution of funds,” which sends so much to New Jersey, New York and Massachusetts. Change may depend on “whether some of the have-not states are willing to say ‘wait a minute’,” Wilensky said. The story http://bit.ly/1nKQAW8 Pro’s earlier story ICYMI: http://politico.pro/1pD6Vst

DELAURO SHAKES UP SODA TAX DEBATE — I really like blue Gatorade, especially in the summer. But am I willing to pay an extra 6 cents for it? That’s what Rep. Rosa DeLauro is proposing in a bill she introduced Wednesday that would levy a penny-per-teaspoon excise tax on the caloric sweeteners in beverages like Gatorade and Coca-Cola and raise as much as $10 billion a year for public health prevention initiatives. But the bill is dead on arrival, and DeLauro knows it, Pro’s Helena Bottemiller Evich writes. It’s loathed by the beverage industry and faces a hostile reception in the Republican-controlled House. DeLauro is optimistic that, as with a 2010 menu labeling act, opposition to the Sweetened Beverages Tax (SWEET) Act will wane. Menu labeling, however, had the support of the National Restaurant Association, while the American Beverage Association is not a fan of taxes as a solution to child obesity. We’ll have to wait and see how much support the SWEET Act finds on the Hill. Good news, guys, chocolate milk is exempted! The Pro story: http://politico.pro/1nKCkNe

ILLINOIS RESTRICTS SOVALDI — Illinois is requiring that Medicaid patients meet 25 criteria and get prior approval before its state program will cover the $1,000-per-pill hepatitis C drug, the AP reports. The state’s Medicaid medical director says that the restrictions are warranted given the lack of research on Sovaldi with minorities and other groups. But doctors are concerned the rules are too stringent. The AP story: http://bit.ly/1zwhULJ

GOP REP’S ABORTION SCANDAL RESURFACES — Abortion opponent Rep. Scott DesJarlais (R-Tenn.), who was blasted in 2012 after divorce proceedings revealed that he had encouraged his ex-wife to have two abortions, is again under fire for that. His rival in the GOP primary is airing an ad that reminds voters that DesJarlais “deliberately deceived” them and declares “scandal makes DesJarlais ineffective in Washington,” according to CQ Roll Call. The ad references other behavior, including the fact that DesJarlais, a physician, had several romantic affairs with patients and co-workers and was fined $500 by a medical board. The Roll Call story: http://bit.ly/1tvsAcS

TRAUMA BILL HEADED TO OBAMA — Ohio Sen. Rob Portman’s bill to expand the federal definition of trauma to include burns passed the Senate Wednesday and is ready for the president’s signature. The Improving Trauma Act of 2014 will enable burn centers to be eligible for funding available to trauma and emergency care programs. Last month, the House passed similar legislation introduced by another Ohio Republican, Rep. Bill Johnson.

PROTECTING ORGAN DONORS — Reps. Michael Burgess (R-Texas) and Jerrold Nadler (D-N.Y.) introduced a bill Wednesday to protect the rights of organ donors. The Living Donor Protection Act would prohibit insurance companies from discriminating against organ donors, denying them coverage or charging them more. The bill would also clarify that organ donors may use Family and Medical Leave Act time to recover from procedures related to their donation. The National Kidney Foundation and several other patient and provider groups support the bipartisan bill.

ICYMI: THE MOST YOU CAN PAY FOR INDY MANDATE PENALTY — The IRS released a rule last week that was mostly about how the premium tax credits apply to complicated family situations like separated couples or abused spouses. But it also laid out the maximum penalty for refusing to get covered. In 2014, your fine/penalty/tax is $95 or 1 percent of household income, whichever is greater. Unless you make too much. Because there's a cap. The limit is the cost of average bronze plans, which is $2,448 for an individual and $12,240 for a family. So the 1 percenters shouldn't actually have to worry about a 1 percent hit on their income. The rule: http://1.usa.gov/1nFsQUv

WHAT WE’RE READING by Jennifer Haberkorn

Health exchanges are a "step in the right direction," Republican Sen. Bob Corker said yesterday at a Wall Street Journal event. http://on.wsj.com/1nLjC8g

The founder of athenahealth, who is also a George W. Bush relative, says that the health industry is the "new oil" — an industry loaded with opportunity that is untapped. http://onforb.es/1tw5umh

Another top doctor has died after treating Ebola patients in West Africa, the AP reports. http://wapo.st/1knE53p

The federal government has made it difficult for marijuana researchers to do their work, Vikas Bajaj writes for the NYT editorial page blog. http://nyti.ms/1rJCWC0

Dr. David Fleming, director of public health in Seattle and King County is leaving his post, The Seattle Times reports. http://bit.ly/1leRpSw

A new Oakland hospital is opening Sunday that features flat-screen televisions and wi-fi for patients, the San Francisco Gate reports. http://bit.ly/1ABfKvG

**A message from the Partnership for the Future of Medicare: For every birthday that Medicare celebrates, the program gets one year closer to bankruptcy. Transforming the system to reward value instead of volume and creating strong private-public partnerships is critical for Medicare’s future. Read more about bi-partisan solutions for sustaining Medicare so it can celebrate for generations to come: http://bit.ly/YbmEYT **

** A message from PhRMA: Diabetes is a complex disease affecting more than 30 million Americans – with one-in-ten living in DC, Maryland and Virginia having the disease. Thanks to advances in diabetes care, patients around the country are living longer, healthier lives. Take five-year-old Rhys for example [link to his I’m Not Average profile]. He was diagnosed with type 1 diabetes at 15-months-old, but today, he is a thriving young boy. This is due in large part to new and innovative medicines developed by researchers and scientists at America’s biopharmaceutical companies. Learn more about the medicines in development for diabetes here. **